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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 August;164(4):275-9
Has it sense to operate on feto-neonatal ovarian cysts?
Comparetto B. 1, Bestini G. 2, Rubaltelli F. F. 2, Borruto F. 3
1 U.O. Ostetricia e Ginecologia, Ospedale Misericordia e Dolce, Azienda U.S.L. n. 4 di Prato, Prato;
2 Dipartimento di Pediatria, Divisione di Neonatologia, Università degli Studi di Firenze, Firenze;
3 Dipartimento Materno-Infantile, Divisione di Ostetricia e Ginecologia, Università degli Studi di Verona, Verona
Aim. The management of fetal ovarian cysts, although the improvement of prenatal diagnosis allowed by ultrasonography, is still controversial. Some studies suggest the opportunity of an aggressive management, while others conclude for a conservative one. The prognosis of the majority of congenital ovarian cysts is good, since they have benign origin. Sometimes, however, complications such as torsion or rupture can occur and often require surgical intervention after delivery. In this paper we report our experience and a brief review of the literature.
Methods. The Authors report on 24 pregnant women in whom ultrasonography revealed the presence of an echo-rare or echo-free area in the fetal abdomen suggestive of an ovarian cyst. Postnatal ultrasound controls confirmed the prenatal diagnosis in all cases.
Results. The diameters of the cysts ranged from 2.7 to 7.5 cm. In the 12 cases in which the cyst diameter was below 4 cm, periodic ultrasound examinations revealed a tendency towards spontaneous regression of the cysts. In the other 12 cases in which the cyst diameter exceeded 4 cm, cystectomy was necessary owing to subsequent development of complications (torsion in 5 cases and intracystic haemorrhage in the other 7).
Conclusions. The most appropriate clinical approach in the management of benign feto-neonatal ovarian cysts is to adopt a wait-and-see policy, assessing the course of the condition by means of periodic ultrasound monitoring. Only in the presence of tumefactions measuring more than 4 cm in diameter with attendant complications surgical therapy is indicated. In the absence of complications, however, aspiration of the cystic contents is possible even in ovarian cysts exceeding 4 cm in diameter.